SHM Converge Scientific Abstract ePoster Gallery-Myocarditis Due to Falciparium Malaria

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This poster describes a rare case of myocarditis caused by <em>Plasmodium falciparum</em> malaria and highlights the importance of recognizing cardiac involvement in severe malaria, especially where cardiac MRI is unavailable. Malaria remains a major global health burden, but myocarditis is an uncommon and likely underdiagnosed complication.

The case involved a 66-year-old man who presented with 5 days of high fever and 6 hours of chest pain radiating to the left shoulder, along with tachycardia, shortness of breath, and splenomegaly. His ECG showed ST-segment elevation, prompting cardiac catheterization, which revealed no coronary blockages. Because he lacked typical cardiac risk factors and had recently traveled to a malaria-endemic region, a blood smear was performed and confirmed falciparum malaria. He then developed worsening fever, chills, headache, and persistent chest pain. Echocardiography showed reduced ejection fraction and cardiac index, and cardiac biomarkers such as NT-proBNP/BNP, myoglobin, and H-FABP were elevated, supporting the diagnosis of malaria-induced myocarditis. He was treated with artemisinin-based combination therapy.

The discussion notes that cardiac involvement in falciparum malaria is poorly understood but may result from direct parasite toxicity, inflammatory cytokines, microvascular obstruction, acidosis, and nitric oxide depletion. Prior studies have found associations between severe malaria and elevated cardiac biomarkers, suggesting potential myocardial stress or injury.

The authors conclude that clinicians should maintain a high suspicion for myocarditis in patients with severe falciparum malaria who present with chest pain or ECG abnormalities. In resource-limited settings, careful clinical assessment combined with echocardiography and cardiac biomarkers may be the most practical approach to diagnosis.

Asset Subtitle

Sasmith Menakuru

Meta Tag

Author List Ahmed Salih, Amir Beirat, Ibrahim Khan, Joseph Emran, Sasmith Menakuru, Vijaypal Dhillon

Category Clinical Vignettes

Concept Plasmodium falciparum malaria

Concept Myocarditis

Concept Chest Pain

Concept ST Elevation

Concept Stable Ischemic Heart Disease

Distinguished Non-Finalist

Presenter Organization Indiana University Health Ball Memorial Hospital

Presenting Author Sasmith Menakuru

Track Adult

Keywords

Plasmodium falciparum

malaria

myocarditis

chest pain

ST-segment elevation

cardiac biomarkers

echocardiography

severe malaria

artemisinin-based therapy

cardiac involvement

Plasmodium falciparum malaria

Myocarditis

Chest Pain

ST Elevation

Stable Ischemic Heart Disease